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EHR Replacement Rush a Regret for Many Struggling Hospitals

Optimism for implementing EHR replacement systems has led to dissatisfaction for many hospitals despite the reported promises of ROI.

By Kyle Murphy, PhD

The fury of EHR replacement over past several years proved costly to cash-strapped hospitals looking for a return on investment from new EHR technology, according to new Black Book research.

The findings from a crowd survey of 1204 hospital executives and 2133 health IT users having completed a recent EHR replacement indicate that 87 percent of cash-strapped hospitals regret their decision in making the switch.

Additionally, 14 percent of all hospitals surveyed report that their EHR replacement implementation and adoption has cost them inpatient revenue incapable of supporting the total cost of ownership of their new EHR technology.

“It was a risky decision as hospitals were facing the fact that they would not be back to their pre-EHR implementation patient volumes, inpatient or ambulatory, for at least another five years,” Black Book Managing Partner Doug Brown said in a public statement.  “No other industry spends so much per unit of IT on the part of the business that is shrinking the fastest and holds little growth as did inpatient revenues.” 

What's more hospital leaders and their staff disagree as to the impact of their EHR replacement technology on healthcare delivery.

Close to two-thirds of health IT staff (62%) reported a "significantly" negative impact on care delivery as a result of EHR replacement efforts, compared to a small minority of healthcare leaders (5%) who reported a similar perspective.

Similarly, a vast majority of nurses (90%) echoed that perspective, specifically noting a drop-off in their ability to provide effective patient care. According to a previous Black Book report published in 2015, a large percentage of nurses (96%) indicated that they were not engaged in the EHR replacement process.

“In our experience polling, most executives will not admit they were oversold or that their IT decisions had adverse bearing on patient care,” Brown explained. “On the other hand, workflow changes and productivity issues may have added to the disappointment nurses felt after being left out of replacement EHR product evaluations.”

Also emerging from the survey were negative factors tied to EHR replacement such as job losses and limited EHR interoperability.

Regarding the former, most healthcare executives (63%) considered their jobs to be in jeopardy as a result of the EHR replacement process. Other findings on job loss include:

  • 7% of respondents at the manager level or higher claimed they or their peers were actually fired or asked to resign directly because of EHR replacement cost or productivity impacts
  • 19% said intermittent or permanent staff layoffs were directly caused by implementation delays, cost overruns, budgets under estimated, or trained personnel unavailable.
  • 19% said intermittent or permanent staff layoffs were directly caused by implementation delays, cost overruns, budgets under estimated, or trained personnel unavailable.

As for EHR interoperability, the findings do not paint a rosy picture. As many as 66 percent of health IT staff reported a decline in interoperability and information exchange following EHR replacement activities.

Other key findings on interoperability include:

  • The automatic buy-in of physicians and other clinicians for certain replacement EHR brands was exaggerated
  • 78% of non-physician executives admit the clinical buy-in they were oversold never materialized after a replacement launched
  • 88% of hospitals with replacement EHRs could not report any competitive advantages to attract doctors based on their new system
  • 80% of IT staff said they felt they had to coerce network physicians into adopting replacement EHRs via the hospital IT department

With changes coming for reimbursement in healthcare stemming from the national-level push for value-based care, these most recent findings portend tough times ahead for many hospitals whose EHR-related decision-making lacked due diligence and end-user engagement.

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